allowed to use taxpayer money for abortion beyond the limits of existing law. we don't stop there. the bill takes special care to keep public and private dollars separate to make sure that happens. this isn't a new concept. it's worth noting that this practice of segregating money is consistent with other existing rules that make sure the public doesn't pay for things it shouldn't. it's consistent with the existing medicaid practice. it gives the states the option of covering abortions at their own expense, and it mirrors the practice already in place to separate church and state by ensuring money the federal government gives religious organizations is not used for religious practices. so we're not reinventing the wheel here. just as current law demands, the bill respects the conscience of both individual health care providers and health care facilities. and once again, it goes further. our bill not only safeguards a

long list of federal laws regarding conscience protections and refusal of rights, but it even outlaws discriminations against those health care providers and facilities with moral and religious obligations to abortion. that means if a doctor does not believe it's right to perform an abortion, he or she can say no. no questions asked. health care facilities like catholic hospitals, which is the largest nongovernment, nonprofit health care provider in the country, will continue to have the same right, to refuse to perform abortions. under our bill, at least one plan that does not cover abortion services will have to be offered in each exchange, so no one will be forced to enroll in a plan that covers abortion services. this is an improvement since the current marketplace doesn't provide a similar guarantee. so it's clear that the current bill does not expand nor restrict anyone's access to abortion, period. it does not force any health

plans to cover abortion or prohibit them from doing so, period. why? because this bill is about access to health care, not access to abortions. i have great respect for senator ben nelson. his integrity and independence reflect on the nebraskans he represents. his strong beliefs are rooted in his strong values, but he shows better than most that one can be steadfast without being stubborn. senator nelson has always been a gentleman whose consideration is a true portrait of how a united states senator should conduct one's self. i mentioned our underlying bill leaves current law where it is. this amendment, however, does not. it goes further than the standard that has guided this country for 3 years. it would place limits not only on taxpayer money, which i support, but also on private money. again, current law already forbids federal funds from paying for abortions.

our bill doesn't weaken that rule one bit. i believe current law is sufficient, and i don't believe we need to go further. specifically, mr. president -- could we have order in the senate? it's terribly distracting. the presiding officer: order in the senate. mr. reid: mr. president, as i mentioned, our underlying bill leaves current law where it is. this amendment, i repeat, does not. it goes further than the standard which has guided this country, as i said, for 33 years. it would place limits not only on taxpayer money, which i support, but also on private money. again, current law already forbids federal funds from paying for abortions, and our bill doesn't weaken that rule one bit. i believe current law is sufficient, and i don't believe we need to go further specifically. i don't believe that the senate needs to go as far as this amendment would take us. no one should use the health care bill to expand or restrict

abortion. no one should use the issue of abortion to rob millions of the opportunity to get good health care. this is not the right place for this debate. we have to get on with the larger issue at hand. we have to keep moving toward the finish line and cannot be distracted by detours or derailed by diversions. our health reform bill now before this body respects life. i started by saying i believe in the sanctity of life. my strong belief is that value does not end when a child is born. it continues throughout the lifetime of every person. with this bill, nearly every american will be able to afford the care they need to stay healthy, to care for a loved one. it respects life. those who today have nowhere to turn will soon have security against what president harry truman called -- "the economic effects of sickness."

it respects life. those who suffer from december from injury or disability will no longer be told by claims adjustors that you never met that they're on their own. this respects life. it will help seniors afford every prescription drug they need so they don't have to decide which pills to skip and which pills to split. it respects life. it will stop terrible illnesses before they start and stop americans from dying of diseases we know how to treat. it respects life. it will stop terrible abuses like insurance companies looking at earnings reports instead of your doctor's report, and charging rates that make the health that we want a luxury. it respects life. we will ensure the most vulnerable and the least prosperous among us can afford to go to the doctor when they are sick or hurt.

not to an emergency room where the rest of us pick up the bill. it respects life. this bill recognizes that health care is a human right. this bill respects life. the issue in this amendment is not the only so-called moral issue in this debate. the ability of all americans to afford and get the access to care they need to stay healthy is also a question of morality. the reason i oppose abortion and the reason i support this historic bill are the same: i respect the sanctity of life. this is a health care bill. it's not an abortion bill. we can't afford to miss the big picture. it's bigger than any one issue. neither this amendment nor any other should be something that overshadows the entire bill or overwhelm the entire process. throughout my entire political career, i voted my conscience on the subject of abortion.

as i said, that decision is based on something personal with me. my vote today will also honor another principle that i believe to the very core, that i will believe until my very last day on earth. we must make it possible for every american to afford a healthy life. i believe that the compromise in our current bill and the current bill itself fully fills both of these moral imperatives. it is my belief that when we are given the trust of our neighbors, our friends, our relatives, the privilege to lead and improve others' lives, we can't turn our backs. we can't turn our backs on the tens of millions of americans who have no health insurance at all, none. not thousands, not hundreds, not millions. tens of millions. we can't turn our backs on the many who do but live one accident, one illness, or one pink slip away from losing that insurance they have.

mr. president, one of the most cherished charters this nation has, drafted by one of our most beloved leaders, declared life to be the first among several of our absolute rights. jefferson put it even before liberty, even before the pursuit of happiness, life. if we still truly value life in america -- and i believe we do -- if we still truly value the life of every american, we cannot turn our backs on the 14,000 of us who lose health care coverage every single day of every week of every month of every year in this country. no weekends off, no vaiks. how many of the -- no vacations. how many of the thousands of men, women, and children who today will be kicked out of the cold will next year become one of the tens of thousands who die because of it? if we value the sanctity of life, as i know that we do, and fix what is broken, as i know we

must, we won't have to find out. i believe in this bill and what it will do for our country for generations to come, what it will do for our constituents, my children, my grandchildren and their children and their grandchildren. i'll not support efforts to undermine this historic legislation. mrs. boxer: mr. president, i ask unanimous consent that the senate proceed to a vote in relation to the nelz--- nelson-hatch number 2 62. that there be two minneapolis of debate prior to a vote in relation to the mccain motion to commit, equally divided and controlled in the usual form. that upon yielding back the use of that time, the senate proceed to vote in relation to the mccain motion to commit. the mccain motion be on a

60-vote threshold. if the motion achieves that threshold, that it be agreed to and laid on the table. if it does not achieve that threshold, that it be withdrawn and no amendment in the motion, and i move to table. the presiding officer: is there objection? without objection, so ordered. mrs. boxer: mr. president, i move to table the nelson amendment and i ask for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be. there is. the question is on the motion to table. the clerk will call the roll. vote:

vote:

the presiding officer: are there any senators in the chamber wishing to vote or change their vote? if not, the yeas are 54, the nays are 45rbg the motion to table has been agreed to. under the previous order, there will be two minutes of debate equally divided prior to a vote in relation to the motion to commit offered by the senator from arizona, mr. mccain. could we have order in the senate, please. without objection.

the presiding officer: the senator from montana. could we have order in the senate, please. please move your conversations off the floor. the senator prosecute montana. mr. baucus: mr. president, the senate is not in order. the presiding officer: would you please -- order in the senate. would you please move out of the well. the senator from montana. mr. baucus: mr. president, the mccain motion to commit on medicare advantage would keep overpayments in the medicare advantage program, keep them,

even though the medicare advisory commission recommends they be eliminated. the mccain motion to commit is a tax -- it is a tax on all seniors to maintain the overpayments to private insurance companies and require beneficiaries to pay higher part-d premiums. that's the tax. the average couple pays today $90 per year just so that insurers can reap greater profits under medicare. a $90 tax per year. the mccain amendment is a raid on the medicare trust fund. medicare advantage overpayments take 18 month months off the lif the part-a fund. there's no evidence of greater quality of care. in most cases it is the opposite. medpac told the congress this year that only some medicare advantage plans are high quality. the rest are not. medpac find that only half the beneficiaries nationwide have access to a plan that -- the presiding officer: the senators's time has expired. mr. baucus: for all these reasons and the others i have in my statement here, i urge us to vote against the mccain amendment because that would be

a vote -- to vote against mccain is a vote in favor of seniors. mr. mccain: mr. president, the senate is not in order. the presiding officer: the senate will be in order. mr. mccain: mr. president, this amendment is just about an earmark. that's all it is. it is about a special deal cut for a special group of people that happen to reside in the state of florida. and i've never -- i'm never so presumptuous. i've lost too many votes trying to eliminate earmarks. what i'm trying to d allow ever- what i am a trueing to do is allow every american enrolled in medicare advantage to have the same protection of their medicare advantage program as the senator from florida has cut out in this bill. that's all it's about. it's about equality. it's about not letting one special group of people who reside in a particular state get a better deal than those who live in the rest of the country. that's all this amendment is b and so w it will probably be vod

down on a party-line voavment you have allowed a carve-out for a few hundred thousand people in the state of florida and have disallowed the other 11 million who have medicare advantage from having their health care cut. that's what this is all about. the presiding officer: is there a sufficient second? there is a sufficient second. the question is on the mccain motion to commit. the clerk will call the roll. vote: #

vote:

the presiding officer: are there any senators in the chamber who want to vote or change their vote? if not, on this vote the yeas are 42, nays 57. under the previous order requiring 60 votes for the adoption of this motion, the motion is withdrawn. the senator from texas. mr. dorgan: mr. president, would the senator from texas yield for a unanimous consent request? i ask unanimous consent that following the prevention by the senator from texas that i be recognized for offering an amendment and following that, that senator crapo be recognized for offering an amendment, and that senator crapo, i believe, wishes to speak two or three minutes following that. then i would be recognized as well for a presentation on the amendment that i have offered. following my presentation, the senator from minnesota, senator klobuchar, would be recognized. the presiding officer: without objection. mr. dorgan: mr. president, senator kaufman would be recognized as a part of the colloquy with senator klobuchar. the presiding officer: without

objection. mrs. hutchison: mr. president? the presiding officer: the senator from texas. mrs. hutchison: mr. president, we have spent the last few days highlighting how this health care reform bill is paid for by cutting benefits to seniors, jeopardizing their access to care. almost $500 billion will be cut from the medicare program. but this bill also imposes $500 billion in new tacks. these are -- in new taxes. these are taxes that hit every american and virtually every business and health care-related businesses. these taxes will discourage investment and hiring. we are in one of the worst economic downturns in the history of our country. we don't need to tell anybody that. we're all feeling it. we know people who are really suffering right now. i look at what has been done in the past when we've had economic downturns, and i look at

president kennedy, president reagan, president bush. they lowered taxes. and what happened? the economy was spurred. lower taxes are proven to spur the economy. and yet, in this bill we see $500 billion in new taxes on families and small businesses. let's walk through some of these taxes. employer taxes, $28 billion in new taxes is imposed on businesses that don't provide health insurance to their employees. and to avoid the tax, an employer has to provide the right kind of insurance, insurance that the federal government approves. it's going to be a certain percentage and have certain coverage requirements. employers who don't provide the right kind of insurance could see a penalty as high as $3,000 per employee. madam president, we should be encouraging people to hire in this kind of environment.

that should be job number one -- creating jobs. and yet, imposing taxes and fines are what is in this bill, and that is not going to encourage hiring -- it is going to discourage hiring. that is economics 101. individual taxes. there are $8 billion in taxes for those who don't purchase insurance on their own. the tax is $750 per person. again, because you are insured today does not mean you will avoid the tax. you must have the right kind of insurance. insurance that the federal government approves and says is the right amount of insurance. how about the taxes on high benefit plans? there are $149 billion taxes on benefit plans that the government says are too robust much these high-benefit plans, cadillac plans, some call them,

would be subject to a 40% excise tax. to make it worse, the tax is not indexed, so it's really a new a.m.t., a new alternative minimum tax that everyone says was not supposed to encroach on lower-income people, but, in fact, it has because it's not indexed for inflation. here we are in this bill, you get taxed if you don't provide enough benefits, and you get taxed if you provide too many benefits. so this is beginning t to sound like government-run health care to me. and i can only imagine how the unions feel because they're the ones who have the high-benefit plans. and here they are under fire because they have too much coverage. medicare payroll tax. this is the new payroll tax that

is imposed on individuals making more than $200,000 and couples making more than $250,000. that tax raises anothe another $54 billion. this additional payroll tax is a marriage penalty. it is not indexed to inflation, meaning, it is another a.m.t. in the making. because today that may sound high, $200,000 and $250,000, but it is a huge penalty, and it could begin to go down in number so that more and more people are affected. you know, this body voted unanimously during the budget debate unanimously that a point of order would be against legislation that would impose -- impose a marriage penalty in the budget.

so we have voted unanimously that a budget point of order would lie if there is a marriage penalty in the budget. so now here we are a few months later and the majority is in the only retreating from the opposition to the marriage penalty, but we now have for the first time in our tax code, or will when this bill passes, a payroll tax marriage penalty. how on earth can we do that? i am going to fight this marriage penalty and i hope that the senate that voted against this concept -- it is a new precedent that could be set in other areas that would say if you are married, you are going to get fewer benefits than if you are single. that is not a precedent that we ought to be setting. and then there is the medical deduction cap. there is a change in our tax

code that would limit the itemized deduction for medical expenses. we always had one that said if your medical expenses go above 7% of your income, that you would be able to deduct anything above that. this bill increases that threshold to 10%. so that if you -- if you are going to get deductions, then this is going to affect people who really have catastrophic accidents, really, really bad, big medical bills, debilitating health conditions or very, very expensive medicines. if you go above 7.5% today you would be able to deduct. but in this bill, it's going to be 10% of your income before the government is going to allow to you deduct these added expenses. and then there is the drug device and insurance company

tax. $60 billion in taxes assessed to insurance companies. $22 billion to prescription drug manufacturers, and $20 billion on medical device manufacturers. the experts have said al, all of the economists have said that these taxes will be paid by the government. of course they're going to be passed on higher premiums for every insurance policies that already there and higher prices for medications and medical equipment. so medications that you take for diabetes, heart disease, medications or medical devices that you need to fight cancer would all become more expensive because every one of them would have a higher cost because the company is going to pay an added fee just for producing these medicines and equipment. so many people today are struggling with their medical bills. they're struggling to fill

prescriptions. why are we bringing costs down? isn't medical costs part of the reason for reform because they are going up? the costs are going up? wasn't point of reform to bring the costs down so more people would have affordable options for health care coverage? what happened to that with all of these taxes on individuals and businesses that are going to drive prices and costs up? in closing, madam president, the bill that is before us imposes half a trillion dollars new taxes at a time when unemployment is soaring and our economy is struggling. you've got half a trillion dollars in cuts to medicare, which is going to severely hurt our senior citizens and their access to health care. and then a half a trillion dollars in tax increases, taxing

marriage, taxing tylenol, taxing high benefit plans, taxing low-benefit plans, taxes if you offer employee health care coverage, and it's not quite enough. this is a tax and spend bill. republicans have repeatedly put forward ideas that would reform our health system, bring the cost down without burdening our employers with more taxes that would keep them from helping our economy by hiring more people. ideas that would increase competition and transparency and ensure access to affordable care. so i hope that while our colleagues are meeting to try to get their 60 votes, which we know they are, that maybe they might consider bringing everybody into this process and listening to other ideas that would not be a government takeover of our health care system, that would not be more government mandates, more taxes,

cuts from medicare services. this is a recipe for disaster for our country, madam president. and i hope that it is not too late for the democratic majority to say, okay, let's get together and try to put together a bipartisan plan that will not hurt the quality of health care that americans have known and expected in our country. one that will bring costs down and make health care more affordable. one that will carrots to our employers, not sticks that will switch them if they don't have the right kind of coverage or the government-approved coverage or the right percentage of coverage. madam president, we can do better and i hope that we will. thank you, madam president. and i yield the floor. the presiding officer: the senator from north dakota. mr. dorgan: madam president, i want to call up s. 2793 as

modified. it's an amendment at the desk and -- s. 2793 as modified and ask for its immediate consideration. the presiding officer: the clerk will report. the clerk: the senator from north dakota mr. dorgan for himself and others proposed amendment 2793 to amendment 3096 as modified. mr. dorgan: i ask that it be considered read. the presiding officer: without objection. mr. dorgan: the senator from idaho is to be recognized next for laying down an amendment. a senator: madam president? the presiding officer: the senator from idaho. a senator: i have a motion at the desk to be called up. the presiding officer: the clerk will report. the clerk: mr. president crapo moves to commit the bill to report the same back to the senate with changes that provide no provision of this act shall result in an increase in federal tax liability for individuals

with adjusted gross income of less than $200,000 and married individuals with adjusted gross income of less than $250,000. mr. crapo: thank you, madam president. as the motion, which has just been read clearly states, this motion would be to recommit -- or to commit this bill to the finance committee. for the finance committee to do one simple thing. and that is to make the bill conform to barack obama's pledge for health care reform and who would pay for health care reform. in a speech that he has given in a number of different places, president obama has very clearly stated, "i can make a firm pledge, no family making less than $250,000 will see their taxes increase. not your income taxes. not your payroll taxes. not your capital gain taxes.

not any of your taxes. you will not see any of your taxes increase one single dime." all this motion does is to -- is to commit this bill to the finance committee to have the finance committee assure that its provisions comply with this pledge. now why would we want to do that? i think most americans are very aware today that this bill comes at a huge price. $2.5 trillion of new federal spending. $2.5 trillion of new federal spending that is offset, if you will, by about $50 billion of cuts in medicare -- $500 billion in cuts to medicare, in fact fact, $493 billion worth of cuts in the first 10 years -- or tax increases. $1.2 trillion tax increases in the first real 10 years of the full implementation of the bill. and there's no question but that much of the tax increase that is

included in this bill to pay for this massive increase in federal spending will come squarely from people in the united states who make less than $250,000 as a family or less than $200,000 as individuals. all that we need to do is to go through this bill to see that by the analysis that we have made so far, it appears that at least 42 million households in america will pay a portion of thi this $1.2 trillion in new taxes. people who are under these income levels to whom president obama made the pledge. i'll have a greater opportunity tomorrow to discuss this motion in more detail. tonight i just have a few minutes to make the introduction and to call up the motion. and we will then get into the fuller discussion of how this bill provides a heavy tax burden on the middle class of this

country in direct violation of the president's pledge. so, madam president, as i conclude, i would simply say a very simple amendment. we can debate about whether the bill does or does not increase taxes. i think that's absolutely clear, on those in the middle class. but all the amendment would say -- all the motion would do is to commit this bill to the finance committee to have the finance committee make the bill comport with the president's -- the president said, "i can make a firm pledge, no family making less than$2 50,000 will see their taxes increase. not your income taxes. not your payroll taxes. not your capital gain taxes. not any of your taxes. will you not see any of your taxes increase one single dime. " that's what this motion accomplishes. with that, madam president, i yield the floor.

mr. dorgan: madam president? the presiding officer: the senator from north dakota. mr. dorgan: madam president, the amendment i have offered with many, many colleagues, the bipartisan amendment, deals with the issue of prescription drugs. and specifically the reimportation of f.d.a.-approved drugs that the american people would be able to access for a fraction of the price that they are charged in this country. the american people are paying the highest prices in the world for brand name prescription drugs. it's not even close. in fact, let me just show the first chart. i've got many, but i'll just show the first chart to describe what brings me to the floor of the senate. here are prices for lipitor. i mean, there are so many people that take lipitor, they probably ought to put it in the water supply someplace. the most popular cholesterol-lowering drugs in

america, perhaps in the world. here's what the american people pay for an equivalent quantity of lipitor -- $125. the same quantity costs you $40 in britain, $32 in spain, $63 in the netherlands, $48 in germany, germany, $53 in france, and $35 in canada. once again, $125 for the american consumer. here are the two bottles of lipitor. it's made in ireland by an american company and then sent around the world. this happened to go to canada. this went to the united states. same pill, same bottle, same company, same manufacturing plant, f.d.a.-approved. difference? well, the american consumer gets to pay three to four times higher costs. fair? not for me, it's not fair. and that's what this amendment's about. this amendment is about freedom, giving the american people the freedom in the global economy to buy the same f.d.a.-approved

drug from those countries that have an identical chain of custody as we do in this country, so an f.d.a.-approved drug that is sold for a fraction of the price. why should we prevent the american people from being able to exercise and see the same savings that every other consumer around the world sees? now, let me see whether anybody recognizes this. prescription drugs are a significant part of our lives, and we are bombarded every single day with ads. so let me -- let me show the demonstration of the push for consumption of prescription drugs at the highest brand name prices in the world. sally fields says on television to us -- i've seen it many mornings as i'm brushing my teeth on the television commercial -- "i always thought calcium, vitamin d, and exercise would keep my bones healthy, but i got osteoporosis anyway, so my doctor started me once a

month -- excuse me -- on once a month boniva. and he told me something important. boniva works with your body to help stop and reverse bone loss. my tests showed i was able to stop my bone loss with boniva. studies show after one year on boniva, nine out of ten women did, too. i've got this one body and this one life, so i want to stop my bone loss, and i did more than that. i reversed it with boniva. so go ask your doctor whether boniva is right for you," she says. some of us need help falling asleep. some of us need help staying asleep. a good night's sleep doesn't have to be an on-off thing anymore. the makers of the most prescribed name in sleep medicine comes controlled release ambienc.r. it's the only one with two layers of sleep. it's a treatment you can consider along with your doctor along with lifestyle changes and can be taken as long as your health care provider recommends.

so go ask your health care provider about ambienc.r. for a good night's sleep from start to finish. does your restless mind keep you from sleeping? do you lie awake exhausted? well, maybe it's time for you to ask whether lunesta is right for you. for a limited time, you're invited to take the seven-night lunesta challenge. ask your doctor how to get seven nights of lunesta free and see if it's the sleep you have been waiting for. get your coupon at lunesta.com and ask your doctor today. oh, they're running the men's room marathon with lots of guys going over and over, and here's the dash to the men's room. guys going urgently. then there's a night game waking up to go. these guys should be in a race to see their doctors. those symptoms could be signs of b.p.h. or enlarged prostate. waking up to go, starting, stopping, going, urgently, emptying, weak stream, going over and over, straining. for many guys, prescription

flomax reducessure nary symptoms associated with b.p.h. in one week. only a doctor can tell if you have b.p.h. and not a more serious condition like prostate cancer. call 1-877-flomax to see if flomax works for you and see if you qualify for $40 off. for many men, flomax can make a difference in one week. there are moments out there that you look forward to and shouldn't have to miss out on them. sometimes bladder control problems can cause unwanted interruptions in life. it doesn't have to be that way. overactive bladder is treatable. enablex is a medication that can help you reduce bladder leaks and accidents for 24 full hours. ask your doctor about enablex. well, i've got a couple dozen more. and most people will understand what this is because they've heard them all. go ask your doctor if the purple pill is right for you. they don't have the foggiest idea what a purple pill is for. they just think, you know, with all these scenes of trees and

green grass and convertible cars and pillow clouds in the sky, if life is like that when you're on the purple pill, give me some purple pills. i mean, that's what this advertising is all about. now, i don't mean to make light or make fun of all of it. prescription drugs are important in people's lives. i understand that. but you know what? you can only get a prescription drug if your doctor prescribes it and believes you need it. these advertisements are telling people sitting at home watching a television program tonight you need to get up and go talk to your doctor and see if you don't need some of these pills. it's trying to create consumer demand for something you can get only because a doctor believes you should have it. well, so that's where we are now with prescription drugs in our country. a lot of people are taking prescription drugs. a lot of these drugs are miracle drugs, and they allow people to stay out of the hospital. they don't have to be in an acute care hospital bed.

if you can manage your disease, your high blood pressure, cholesterol with medicine, good for you. that's a good investment. i understand all that. but this consumer demand-driven urge for prescription drugs is pretty unbelievable. go talk to a doctor and ask that doctor what happens every single day in the doctor's office. somebody is coming, saying i wonder if i shouldn't be taking some of this medicine. i wonder if -- i read about or i saw the advertisement. i wonder if i shouldn't be taking some of it. so it's quite a deal. you produce all of this demand with dramatic amounts of marketing, promotion, and advertising, and then you jack up the price and keep it up. and so then the question is well, who can afford this -- these prescription drugs? who can afford it? and so that's what brings me to the floor of the senate today saying that when the american people are charged the highest prices for brand name drugs, and this year it goes up very close

to 10% once again in prices, at a time when we have almost no inflation, isn't that pricing prescription drugs out of the reach of too many americans? and so we are now talking about health care reform, and there is nothing, i repeat nothing in any of this legislation in the house or the senate that addresses this question of the steep and relentless price increases on prescription drugs. there is nothing in any of this legislation that does that. and the question is shouldn't we be addressing this as well? well, i talk about lipitor. let me show you plavix. you see the u.s. price here? the united states consumer gets to pay the highest prices in the world. nexium, if you want to buy nexium, you get to pay $424 here in the united states, $41, 1/10 the price in england, $36 in

spain, $37 in germany. now, the question is this: if this nexium is an f.d.a.-approved drug -- and it is -- made in plants that are f.d.a. approved by our own food and drug administration -- and it is -- then why should an american citizen not be able to access this drug from here, from here, from here? why? because the pharmaceutical industry doesn't want them to, and they have had enough friends around here to keep in place a law that prevents the american people from reimporting these drugs. that's why. and that's what this amendment's about. this amendment says give the american people the freedom to access f.d.a.-approved drugs where they are sold at a fraction of the price. now, madam president, there's a lot to talk about, and i'm going to describe a number of the circumstances that have brought us to this point. this is the place for this amendment.

not some other place. this is the place. this is about health care. we have been told over and over and over and over again that our problem is that health care is consuming too large a portion of the gross domestic product in this country. roughly 17.3%, i believe. all right. part of health care -- not the largest part but one of the fastest growing parts is prescription drugs. so if the issue is health care is rising in cost relentlessly and it's consuming too large a portion of our g.d.p. because we spend much, much more on health care than anybody else in the world, by far, it's not even close, if that's the case, and if one of the fastest rising areas of health care is drug costs, prescription drug costs, then why would legislation that leaves this chamber or leaves the house of representatives not include something that addresses these unbelievable price increases for prescription drugs? how is it we would allow that to

happen? i don't know how we got to this point without having it in the bill, but i sure aim to try to put it in. i understand, by the way, that there is tremendous pushback by the pharmaceutical industry. if i had this sweetheart deal they have, i would fight to the finish to try to keep it. i understand that. and by the way, let me just -- as i have always done and no one ever hears it very much -- certainly the pharmaceutical industry will never hear this -- i think some of the things the pharmaceutical industry does for this country are laudable. i say good for you. they talk about the prescription drugs they produce. good for them. a substantial portion of that comes from research that we have done and paid for at the national institutes of health with taxpayer funds, but that doesn't matter to me. that information ought to be available to the pharmaceutical industry and is so that they can produce these new miracle drugs. good for them. i commend them for it. my beef with them is not that they produce drugs, pharmaceutical drugs that help

people at all. i'm all for that. my beef is the way they price those drugs, saying to the american people you pay the highest prices in the world, and there's not a thing you can do about it. that's my beef with the industry. it's their pricing policy and it's just not fair. how many in this chamber have visited with somebody at a town meeting someplace -- i have -- and they come up to you -- in this case, an elderly woman close to 80 years old and touched me gently on the elbow and said senator dorgan, can you help me? and she was talking then about how many prescription drugs she had to take and how little money she had to pay for it and how she always had to try to determine what her rent cost was and how much groceries she could buy so she could determine how much she had left to pay for prescription drugs. how many of you have had people come up to you saying yes, i take the prescription drugs my doctor asks me to take, but i cut them in half because i can't

afford the whole dose. i just can't afford it. all of us have heard that. the question is are we going to do something about it? this is a chart that shows price increases in 2009. enbrel for striets up 12% this year. singulair for asthma up 12%. boniva up 13%. nexium for ulcers up 7%. now, madam president, i wanted to talk just a bit about the -- the issue of drug prices versus inflation, and this chart shows what has happened to the price of prescription drugs, the red line and the inflation rate in this country, and it describes why it is urgent that we do something, why we can't allow a health bill, a health reform bill to leave this chamber and

do nothing about the issue of prescription drugs. we must at least address this question of whether the american people shouldn't have the freedom to access these identical drugs where they are sold elsewhere for a fraction of the price. but you see the line. this year, 9.3% increase in brand name prescription drug prices at a time when inflation is going down, we have had deflation. that is not justifiable. now, madam president, i -- i know that we're going to have a lot of debate here in the chamber about a lot of things, and i'm going to -- i'm going to describe tomorrow morning when i speak that 40% of the ingredients, 40% of the active ingredients in u.s. prescription drugs currently come from india and china. and they're worried about somebody from sioux falls, south dakota, buying prescription drugs from winnipeg. are you kidding me? 40% of the active ingredients in

u.s. prescription drugs currently come from india and china, and in most cases, the places that those active ingredients come from have never been inspected. and i'm going to talk about that. i'm not going to go into it tonight, but i'll -- i'll talk about a number of issues related to drug safety of the existing drug supply and how what we have included in this legislation with respect to pedigree and batch lots and tracers will improve dramatically the existing drug supply in our country and make certain that there isn't any safety -- any safety issues at all coming from the reimportation of drugs. now, i'm going to speak to this at some length tomorrow, but i just received a letter from the head of the f.d.a., margaret hamberg, food and drug administration, who raises some questions about the amendment. i'm not going to read the letter into the record. i'll talk more about it tomorrow. i must say that i am in some ways surprised by the letter and in some ways not surprised at

all. surprised because this administration, president obama, was a cosponsor of this legislation last year here in the united states senate, a cosponsor of my legislation. he was part of the bipartisan group that believed the american people ought to have this right and believed that we could put together a piece of legislation that has sufficient safety capabilities and, in fact, dramatically enhances the safety of our existing drug supply. i'm going to show tomorrow that the existing drug supply has all kinds of issues. i'll show batch lots of existing drugs that have gone through strip joints in the backroom in coolers and distributed out of strip joints. i'm going to talk about that. but first i want to say that i was surprised to get this, because both the president and the chief of staff at the white house were a cosponsor in the senate and a leader in the house for reimportation of prescription drugs. now, i called the head of the f.d.a. yesterday afternoon about

this time and said, i have heard rumors that there was a letter coming to capitol hill on this issue. she told me she was not aware of such a letter. 24 hours later, apparently she is aware of that letter because she signed it. i'm interested in where it was written but that's another subject i'll save for tomorrow as well. madam president, we will be told, as we have so often, that if you allow the american people buy prescription drugs that are f.d.a. approved from elsewhere, it will be somehow unsafe. the implication is that we are not smart enough and we are not capable enough of putting together a system that the european have had together for 20 years. in europe, they do it routinely. for 20 years, they've had something called parallel trading. you're in germany, want to buy a prescription drug from spain, no

problem. you're in italy, want to buy a prescription drug from france, no problem. they have a specific parallel trading system and it works and works well. and i'm going to describe, in the words of someone who's been involved in that system for many years, that the europeans can do it, have done it, do it today with no problems at all. are people really saying that they can do it, they're smart enough, they're capable enough but we aren't? give me a break. that makes no sense to me at all. of course we can do this. it's just that those who don't want to do it have decided that this current deal -- and i use "deal" with quotes -- "the current "deal" which allows the pharmaceutical industry to price as they wish in this country and make certain the american people can't do anything to get the lesser prices in other countri countries, the lower prices for the identical drug, it means that they price this year up

9% -- 9.3% just this year alone. they'll do whatever they want to price those prescription drugs and too often will price them out of reach of the american people. it's not fair, to me. doesn't make any sense, to me. now, i know that some will view this as just an attack on the pharmaceutical industry. it's not intended to be that. i don't -- i don't -- as i said, i don't have a beef against that industry at all. the only problem i have is the way they price their product, and i think it's not fair to the american people. we're dealing with -- with health care which is a big issue and an unbelievably controversial issue. this is one piece of it, not even the biggest piece, but it's a very important piece. madam president, i'm -- i've got a lot to say tomorrow morning and i'll take substantial time. i know there are others who are going to want to speak tonight. but i want to -- i want to say this. i have watched and listened in this chamber now for some while.

i haven't spoken a lot on health care. i've been pretty distressed with some of what's been said on the floor of the senate and i've especially been distressed with the television ads that are running that are just unbelievably dishonest with respect to the facts. and, you know, the first amendment allows all that and i -- i'd be the last to suggest that we ought to alter the first amendment. but this is -- this is a great country in which we live and -- and over the last century, for example, we have made a lot of changes, and in most every case, in most every single case, the changes have been unbelievably painful. i think of the presiding officer and think of the period in which the women in this country wanted the right to vote and were taken to the occoquan prison and beat hbeaten. lucy pearl, alice paul. nearly choked to death, one of them. the other hung from a chain from

a prison door all night long with blood running down their arm. why? because they wanted the right to vote. think of the pain of that. looking back, how could anyone have decided that -- we're all human beings, think of that. you can go right up the line. social security, a communist social plot. medicare? what are you thinking about, a takeover of the -- of health care for senior citizens. i'll bet there's not -- i was going to say i bet there's not one -- i probably shouldn't say that. i bet there aren't more than two, three people in this chamber that if we said, let's get rid of medicare, who with say "yeah, let's do that." almost everybody believes that providing health care for senior citizens was the right thing to do. almost everybody. you know something in there was n?there was no insurance company out there in the 1950's and early 1960's that decided here's our business strategy. our business strategy is to go look for old people and see if we can't sell them health insurance because we think that would be a really good deal. they weren't doing that. they wouldn't even make health

insurance available to a lot of old folks because they know that somewhere towards the end of their lives, they were going to need a lot of health care. so one-half of the senior citizens in america had no access to health care. think of that. lay down in your pillow at night, were frightened that tomorrow might be the day, that you get this dreaded disease and you have no coverage to go see a doctor, get to a hospital? unbelievable. so some people through this chamber said let's do me do med. man, that was radical. people said, you know, socialist plot, government takeoverment but we did it. i wasn't here. but they did it. god bless the ones who did it and enriched this country, to say all of those who had lived their lives and built the roads and built the schools and built the communities and left a better place for us, to say to them, you're not going to have to lay awake at night flight inned about your health care, we're -- frightened about your health care, we're going to provide health care for you. all of these issues have been difficult, draining, wrenching issues and they've all provoked

great criticism and great anger in many cases. this issue of health care brought to the floor of the senate is, you know -- i, perhaps, would have a different view of what is the priority. i'm -- i've spent most of my time saying the economic engine, restart the engine, get people back to work. but that doesn't mean health care isn't important. health care continues to gobble up more and more of this country's economy. and at some point, somebody has to say, how do we stop that, how do we fix that? if we're spending much more than anybody else, how do we fix this? that's what this is about. and it's going to take some courage to do it. now, one piece of it is this issue of prescription drugs and pricing. and some of us have been working on this for a long, long time. you know, the breadth of the support for this in this chamber extends from the late senator ted kennedy, who sat in that seat back there -- and god bless his memory -- it extends to john mccain over there, extends to senator chuck grassley, debbie

stabenow, amy klobuchar, and a whole series of republicans and democrats who have come together to say, do you know what? let's make sure there's fair pricing for prescription drugs for the american people. we're not asking for anything other than fair pricing. and how do you get it? my goal isn't to ask the american people to buy their prescription drugs overseas. my goal is to say, if we allow the american people the freedom to do that, the pharmaceutical industry will be required to reprice their drugs in this country. it's just as simple as that. now, madam president, i know others wish to speak and i -- as i said, i've got a lot to say tomorrow. i'm kind of -- i'm going to go kind of upset about this letter today from the f.d.a., which is, in my judgment, completely bog bogus. i'll read it tomorrow. but, you know, i'm not surprised. i expected this. heard rumors about it. but tomorrow, may hope is with my colleagues, republicans and democrats, we will pass this legislation at last, at long, long last. many of us have been working on this six, eight, ten years.

we will pass this legislation. why? because this is the place for it. this is the bill that should be amended. this is the time to do this. we cannot walk out of this chamber and say, well, something happened in that chamber to deal with health care but did do you something about prescription drug prices? no, we couldn't do that. couldn't do that. that is not the way i want this to end. and it's not the way it has to end if enough of us have the courage to take on this fight. now, madam president, as i said, i will have a lot more to say tomorrow morning. i appreciate the indulgence of my colleagues to listen tonight about why we have introduced this legislation. i started and let me finish by saying this is broadly bipartisan. it is first and foremost a dorgan-snowe bill. senator dorgan, myself, senator snowe from the state of maine. but many others, my colleague, senator grassley from iowa on the floor, senator mccain, who spent a lot of time on this issue, republicans and democrats come together. and by the way, this hasn't happened very often on this

bill. this hasn't happened very on which. but this is a bipartisan bill with republicans and democrats that will be pulling the ores together to try to get this done. madam president, i yield the floor. mr. grassley: mr. president? the presiding officer: the senator from iowa. mr. grassley: before the senator from north dakota leaves and before i speak on another issue, i want to tell him tomorrow, i'm going to speak in support of his amendment but i'd like to ask him a question now, if he would answer for me, and a friendly question but it's something i don't know absolutely for sure. but i believe, senator from north dakota, that pharmaceuticals is about the only thing that a consumer in the united states can -- can't buy anywheres in the world they want to buy it from. and we ought to give them that same right we do on everything else. now, there may be some other items i'm not aware of but i

think it's only pharmaceuticals that you can't import from wherever you want to, to buy that. mr. dorgan: well, i say the senator from iowa, and cigars from cuba, we have a special embargo with cuba. i don't think there is a legal product that the american consumer cannot access anywhere else in the world. this is about giving the american consumer the freedom that the global economy should offer everybody. the big shots have got. it how about the american people having the opportunity to shop around the world for the same product and pay a fraction of the prices for what's imposed on them here in the united states. mr. grassley: i'd like to thank the senator from north dakota. i'd like t -- ms. klobuchar: i'm trying to figure out the order of who's speaking next.

the presiding officer: under the previous order, the next speaker is to be the senator from minnesota, followed by the senator from delaware. mr. grassley: unanimous consent to be able to speak now, if i could. the presiding officer: is there objection? mr. kaufman: how long -- mr. grassley: 15 minutes. the presiding officer: the senator from minnesota. ms. klobuchar: i believe our speech is about 10 minutes and if the senator from iowa could wait for 10 minutes, then we'd be able to complete our speech as was recognized by the chair. the presiding officer: the senator from iowa. mr. grassley: i'll let the senator speak, and i'll speak tomorrow because i have to go to a meeting. so i'll just let the unanimous consent -- ms. klobuchar: i wasn't aware that the senator from iowa has to leave. if that's fine. if he could keep it to 10 minutes. that would be helpful to us. mr. grassley: i can't keep it to

10 minutes. and i don't want to short 10 up. so i'll let the unanimous consent request stand. mr. kaufman: thank you. the presiding officer: the senator from delaware. mr. kaufman: the senator from minnesota and i will engage in a colloquy. we rise today to talk about health care fraud enforcement. fraud is one of the most costly crimes in america today. in no small part our current economic crisis can be linked to financial fraud. starting with the unchecked mortgage fraud by loan originators through security fraud that hastened the market crash and maximizes impact on main street and the average investor. in response this body passed the fraud recovery act. which directed critical resources and tools. i was proud to work with my friend from minnesota, a foam prosecutor, who understands very he'll well the harm that financial fraud causes on americans and the importance of deterring criminal behavior

before it happens. senator klobuchar? ms. klobuchar: thank you very much, senator kaufman. i'd like to acknowledge the amendment by senato senator dorn drug importation, something that i support, and i know that senator kaufman supports as well and we look forward to talking about that as well. the bill that senator kaufman referred to, the fraud enforcement act, was passed in part to an unprecedented financial crisis. i was proud to work on that bill in the senate judiciary committee, along with senator kaufman. americans should expect congress to do more than simply react to crises after the most destructive impacts are felt. we're always coming in after the fact, putting out the fire. that's not what we want to do. we want our constituents to be proactive and seek out and solve problems on the horizon so that financial disasters can be averted. in the midst of a deconcerning

comprehensive health care reform, we must be proactive in combating health care fraud and abuse. each year individuals drain $72 -- $72 billion and $220 billion from private and public health care plans through fraud, increasing the cost of medical costs and undermining the trust of the health care system. think about all of the money wasted, $72 billion t to $220 billion each year, drained by criminals that could be going to our seniors, could be going for care. let me just give you a couple of examples senator kaufman of the kinds of fraud that we need to address. on june 23 of this year eight individuals were indicted in miami for cashing $30,000 t to $80,000 several times a week at two check cashing facility that's they own themselves. these clerks defrauded the u.s. health care system by creating phony clinic, that churned out

medical bills in five states. they didn't provide health care, they were phony clinics. some of the purported clinics were empty store fronts with handwritten signs while others existed only as post office boxes, but none provided actual medical services according to prosecutors. by the time they were caught, this one incident, this one group of conmen bilked the government of $100 million at a time when our taxpayers are trying to save every dime, holding on to their jobs, trying to pay their bills. this conmen -- these conmen conmen, $100 million. in 2007, the department of justice indicted a woman for -- and for children's psychotherapy services not provided. according to the indictment the woman then laundered the money through a houston check cashing business cashing several medicaid checks each for more

than $10,000. those are just the examples of what we're dealing wsm. mr. kaufmanwith. mr. kaufman: these are the kinds of examples of fraud that we must stop. as we take steps to increase the number of americans covered by health insurance, and improve the health care system for everyone, and we will do that, we must ensure that law enforcement has the tools it needs to deter, detect and punish health care fraud. the finance and "help" committee as well as leadership have worked long and hard to find ways to fight fraud and bend the cost curve down and they have done a great job. but there's more work to be done. that's why senato senator klobud i and leahy, kohl, and harkin, enforced 2792. ms. klobuchar: what i like about this amendment is that it will increase our protection of help for americans in the -- we

decided that people shouldn't be thrown off of health insurance by preexisting condition. the way that we make sure that the funds are there to help peep sl by doing things like increasing the tools that we need to prosecute these kinds of cases. these criminals scheme the system to rob the american taxpayers of money that should be used to provide health care to those that need it most. we must put a stop to this and we are doing with this amendment. it provides straightforward, but critical improvements to the federal sentencing guidelines, to health care fraud statutes to for fit iewrks money laundering, obstruction statutes, would strengthen the prosecutor's ability to combat health care fraud. as a prosecutor, when we had these type of cases, every tool you you could use to push someone to plead guilty to make sure that you could get the maximum sentence that you could possibly get to send the message not only to that particular

criminal, but to other white collar offenders that this may be a way to make a buck, that you can be caught and go to jail. senator kaufman, you have been taking a lead on this. if you could provide the detail on this bill. mr. kaufman: it directs the increase in sentencing guidelines for large-scale health expenses. analysis from the u.s. sentencing commission suggests that health care fraud offenders often receive, i know this is hard to believe, shorter sentences than other white collar offenses in cases with similar loss amounts. for some reason people think that health care is ok. ms. klobuchar: if people knew this, they would be shocked. you're taking money from the people who need it most when people are in the hospital, this would have shorter sentences than other kinds of fraud. mr. kaufman: and there is data to show, which makes good common

sense that criminals are drawn to health care. they decide, what kind of fraud will i do? because the -- the risk to reward ratio is so much lower. that's ridiculous. we need to ensure that these offenders are punished not only with the cost that they impose on the health care system, but also as a level that will offer real deterrence. people have to understand that they cannot commit health care fraud. there are so many ways that can be presented that if in fact they do it they will get real time for the crime. our amendment directs that the sentencing guidelines, as a practical matter will increase 20% to 50% for health care crooks stealing over $1 million. ms. klobuchar: the other thing that's great about this bill, senator kaufman, is that it updates the definition of health care fraud offense in the federal criminal code, so it includes violation of the anti-kickback statute, the food and drug cosmetic act and certain provisions of arisa, it

will allow the full array of law enforcement tools to be used against all health care fraud. the amendment also provides the department of justice with subpoena authority to investigations conducted pursuant to the civil rights act for institutionalized persons act. under current law the department of justice must rely upon the cooperation of the nursing homes, mental health institutions and residential schools for children with disability that are the target of these investigations. while such targets often cooperate, they sometimes do not. and the current lack of subpoena authority puts vulnerable victims at needless risk. finally, in addition to the very important piece of this bill that senator kaufman have pointed out, where we're actually increasing the ability to get better criminal penalties, the amendment corrects an apparent drafting error, but providing that obstruction of criminal

investigation involving subpoena investigations under hippa, should be treated in the same manner as obstruction of criminal investigations involving grand jury subpoenas. senator kaufman and i plan to file an additional health care fraud amendment that would require direct depositing made to all providers unmair and medicaid. this bill is incredibly important because the medicare regulations already require direct depositing or electronic transfer. but these regulations have not been uniformly enforced and criminals are taking advantage of this system. again, i ask the question: why would we want this money money, $60 billion estimated for medicare fraud alone, why would we want this money to go to conmen and crooks, people setting up fake store fronts with fake signs that say doctor's office, that we want that money to go there instead of to the hard-working people of this country that can hardly

afford their health insurance. transoutrage. that's why i'm so glad that you, senator kaufman, has taken a lead on, this and that we have prosecutors working on this in the judiciary committee to work on the health care reform bill. americans have waited too long for these kinds of changes. mr. kaufman: that is -- this will help cut down on the fraud. this is a bipartisan issue. if there ever was a bipartisan issue, i don't know anyone who doesn't think we have to do more in terpts of health care fraud. we have $70 billion to $220 billion a year in health care fraud, we have to do everything we can to stop it. as we consider debate of meaningful health care reform, we must be concerned that criminals that engage in health care fraud and those who contemplate doing so, understand that they face swift prosecution and substantial punishment. when the time comes senator

klobuchar and i along with our fellow co-sponsors urge our colleagues to support these amendments -- this amendment. mr. president, i -- madam president, i yield the floor. quorum call:

mr. kaufman: madam president? the presiding officer: the senator from delaware. mr. kaufman: madam president, i ask unanimous consent to speak as if in morning business. the presiding officer: without objection. mr. kaufman: madam president, i rise today to speak about the afganistan strategy president obama announced earlier this week. the dilemma facing the president and our national security team in afganistan is one of the most complex and difficult i've seen in more than three decades of public service. president obama's speech laid out a bold plan and he is deliberative and courageous in

his approach. at the same time, though, i share the concerns about many americans about the challenges that lie ahead for our troops. sending young women and men into harm's way is the most difficult choices we face. each life lost is one too many. and each warrior coming home wounded is one too many. the decision in afganistan is especially difficult because four primary questions remain. the first question is: do we have a trust and effective partner in president karzai. no many how many troops we deploy, we cannot succeed with an afghan government plagued by corruption much we cannot defeat al qaeda without pakistan's support. the third question is: can we

accelerate the training of afghan national security forces? today there are too few afghan security forces to clear and hold against the taliban and they are not capable of taking over for u.s. troops. in light of the president's 18-month deadline, it is clear that self-sufficiency for the afghans is not optional. it's mandatory. secretary gates confirmed for me in last week's senate foreign relation committee hearing that july 2011 is a firm deadline. in 18 months we will begin our withdrawal. and he said, along with senator clinton and chief of staff -- chief of operations mullens, that under no conditions will we send additional troops after this deployment. the fourth question is: do we have enough qualified u.s. civilians in afganistan to partner with the afghan people in promoting governance and economic development? we must send even more.

an ensure that the civilian surge extends to all 34 provinces so they can partner with the afghans in the field. madam president, as you know, i visited afganistan in april and september and had opportunity to speak with our military and civilian leaders, president karzai, and numerous afghan ministers, i traveled and met with the local government officials and tribal elders and the community council. what i heard from the afghan people was frustration with our government's inability to provide security and administer justice and deliver the very basic services. they welcomed international assistance in the short term, but sought improved security and governance. more importantly, they want to control transfer to afghan security forces once they were capable of holding against the taliban. let me repeat that. in afganistan, the people there, they want to control transfer to

afghan security forces once they were capable of holding against the taliban. since -- since returning from afghanistan, my number one concern has been the ability of the karzai government to be an effective partner. in the second term, president karzai must eliminate corruption, deliver essential services in order to win the trust of the afghan people. ultimately, ultimately, the battle is not between the u.s. and the taliban. it's a struggle between the afghan government and the taliban and the fight must be won by the afghans themselves. the notion of a corrupt government has emboldened the taliban and furred undermined trust between president karzai's people. president karzai must translate his promises in his inauguration speech into action because increased transparency in government accountability is absolutely critical. for me, the key point in president obama's speech was

that our military commitment is not open-ended. in july, 2011, we will begin our troop drawdown. this has created an 18-month deadline for progress. injecting a sense of urgency to our mission that has been missing for the past eight years. it sends a clear message that the clock is ticking for the afghan government to eliminate corruption. they will no longer get blank check because the time for action is now. on the security front, the afghan national army and police have no choice but to assume greater responsibility given the certainty of a u.s. withdrawal. as president obama outlined, pakistan is central to this fight. we cannot succeed without its cooperation because developments in the region are inextricably tied to both sides of the border. after my april visit, i was concerned about the pakistani commitment. when i returned in september, however, i was impressed by the pakistani military's decision to

go after elements of the taliban in the swat valley. however, at the same time, pakistan must take action against the afghan taliban in al qaeda which continues to find safe havens in pakistani tribal areas. if extremists continue to operate freely between afghanistan and pakistan, it will undermine security gains made on the afghan side of the border, and the stakes are even higher in pakistan which has both nuclear weapons and delivery vehicles. in afghanistan, we must break the momentum of the taliban by improving security and strengthening our ability to partner with the afghans. that is why i support efforts to accelerate the training of the afghan national security forces. i am concerned that the president's goal of increasing the afghan army to 134,000 in 2010 does not go far enough in building the capacity of the

ansf. by comparison, it worries me, by comparison, iraq, a geographically smaller country with the same sized population, has 600,000 trained security forces. that is why we must accelerate our targets for building the army and improve the capability of the police which has faced even greater challenges in terms of corruption in its competence and attrition. finally, our success in afghanistan depends on more than troops, much more than troops. we need an integrated civilian military strategy in order to sustain progress. many dedicated u.s. civilians continue to serve in afghanistan, and we must further august many these numbers and ensure they can directly interact with afghans in the field. given their role as a force multiplier for the military and international nongovernmental organizations, this is an area where we must channel even more resources and people in the near term. we need a stronger civilian

capacity because counterinsurgency cannot and should not be conducted with the military alone. over the coming months, i will closely monitor our progress in afghan governance, partnering in pakistan, building the afghan national security forces and increase the u.s. civilian surge. improvements in these areas are critical to overall success in afghanistan and will determine when our brave men and women in uniform can return home. thank you, mr. president. and i yield the floor. a senator: mr. president, i note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

the presiding officer: the senator from alabama. mr. sessions: i would ask that the quorum call be dispensed with. the presiding officer: without objection, so ordered. mr. sessions: mr. president, i see my good friend, senator kaufman and klobuchar talked about actions we could take to deal with fraud in health care, and i support that and had the opportunity in the past as a united states attorney to lead a group that would do that, but something is troubling me today

a great deal, and i'm uneasy about it and it goes to the heart of how the legislation that's before us today has been put together. we had senator mccain offering an amendment to say that every state should have the same policies with regard to medicare advantage that the state of florida has. presumably that was an effort to gain some support. we have seen other situations like that with louisiana and other places getting special advantages. let me tell you about something that's particularly troubling to me. it was written about by robert reich who was the secretary of labor in president clinton's cabinet, a prolific writer about many matters of economics and health care. and he starts his sunday,

august 9, article this way on his blog. he says -- "i'm a strong supporter of universal health insurance." he's not pulling any punches there. he believes in a single-payer government policy. then he goes on to say -- "and a fan of the obama administration, but i'm appalled by the deal the white house has made with the pharmaceutical industry's lobbying arm to buy their support." now, that's a pretty serious charge. he goes on to say -- "last week after being reported in the los angeles times, the white house confirmed it had promised big pharma that any health care legislation will bar the government from using its purchasing power to negotiate lower drug prices. that's basically the same deal

george w. bush struck in getting the medicare drug benefit, and it's a proven bonanza for the drug industry." and i will say as i recall that mr. reich was a critic at the time of that. and right or wrong, it was done and he was a critic of it. i give him credit for it. and he said -- "a continuation of that would be an even larger bonanza." he goes on to describe why he thinks it's a bonanza. well, right or wrong, as a matter of policy and so forth, it is no doubt that that is something that the big farmer would like, and he goes on to say this -- "in return, big

pharma isn't just supporting universal health care. it's also spending lots of money on tv and radio advertising in support. sunday's "new york times" reports that big pharma has budgeted $150 million for tv ads promoting universal health insurance starting this august." and he puts in -- i'm quoting him. "that's more money than john mccain spent on tv advertising in last year's presidential campaign," close paren. "after having already spent a bundle through health advocacy groups and families u.s.a." well, i don't know what's happened. there is a memorandum in i believe one of the blotion here on the huffington post that is supposed to be the memorandum that documents the agreement.

i don't know what the facts are, but i know this -- that it's not a healthy thing that somebody who has been involved in federal law enforcement or a government official under the color of right to say to a private individual you will help me with an advertising campaign and spend your private money or i will do you a favor in exchange for an $80 million television campaign. i just want to tell you that's not -- that's beyond the pale, and if things like this have been done in the past, it's not the kind of thing that ought to be continued. and i think it's a big deal, and "the new york times" has

reported that as they go forward forward -- "shortly after striking down agreement, the trade group and the manufacturers of america, phrma, also set aside $150 million for advertising to support health care legislation." "an industry official involved in discussions" -- i'm quoting here of the "new york times" article by duff wilson -- "industry officials involved in the discussion said the group and its advertising money would now be aimed specifically at the approach being pushed by mr. baucus, democrat of montana, and the chairman of the senate finance committee." is that the way this thing is being done? i hope not. and i intend to look at that in

more detail, but i just want to say right now and today i'm not happy about it. i don't like the looks of it. it doesn't smell good to me. it does not strike me as something that's legitimate, and i think maybe we need to find out more about it, frankly. mr. president, i have -- i would just want to share with my colleagues a fundamental concern i have with this health care bill. it made a great deal of promises. it alleged it would do a lot of very great sounding things, and we were asked to support it on that basis, but a careful examination of the legislation shows it fails to deliver on almost all of the major promises that it made, and it's likely to cause a great deal of adverse

consequences, some of which are unanticipated, and as a result i think the american people have intuitively understood this, and that's why they are so strongly opposed to it, and they can't imagine why the leadership of this senate continues to try to push down on their brow this piece of legislation that does not do what it promised to do. for example, the sponsors of the legislation say the bill's total cost is $848 billion. well, they don't start the benefits of the bill until five years, and that $848 billion is the cost of expenditures over ten years. so when you back up to when the benefits actually start, for those who will be receiving benefits and go ten years from that, it's not $848 billion.

it's $2.5 trillion. now, that is a huge difference. it's a monumental difference. it's a difference so large that i can't understand how we can with a straight face try to contend that we have a sound budget bill that's going to cost cost $848 billion and we have tax increases of about half of that and raids on medicare for about half of that and that's how we're going to pay for it. really, it's not working that way, in my view. another promise for the bill that was made by the president in the joint session to the congress, he said this -- "this bill would not add one dime to the deficit." that's just not accurate. you can make anything be deficit neutral if you pay for it by slashing medicare and taking the money from medicare and pay for

it, or you can make a bill be deficit neutral if you raise enough taxes so they are raising raising $494 billion in taxes, they are cutting medicare by by $464 billion, and that was the plan. and they claim they have a a $130 billion surplus, so don't worry about the budget. we've created a bill that's going to reduce the deficit, and that's what they have said repeatedly. but they forgot something. they forgot we have to pay our physicians. that was always supposed to be part of health care reform. in fact, the physician groups were told they were going to be paid, but under this bill, to show you how it's been doctored -- and this has been done before. republicans have participated in this in the past, and it's been something that has been going on for a decade, but it's really relevant today particularly in

this legislation because this legislation was supposed to fix that. under the bill, they keep the physicians' rates slightly above last year's rate for one year, and then for nine years in the ten-year budget, they assume that doctors' payments, physician reimbursements are going to be cut 23%. well, that's unthinkable. we are not going to cut the physicians 23%. we can't cut the physicians at all because they already are wondering whether or not they are going to continue to take medicare patients and even more so medicaid patients where they get paid less. and we could have a mass walkout of physicians who couldn't afford to do this if we were to cut it 23%. and, in fact, we're not going to do it. we all know that. so what did they do?

i could know they were meeting down no these hallways somewhere and they were plotting out this bill and they said the president said it will not add to the debtdebt, what are we going to ? the numbers don't add up. we can't raise taxes anymore, we can't cut medicare anymore, we've done all we can do, what are we going to do? and so what they obviously decided was to take the physician part of the bill that needed to be in it that would -- for the -- to fix this aberrational law we've got that requires it to be cut 23%. they put it in a separate bill, every penny of it would be paid for by increased debt, not paid for at all. and they offered that bill on the floor and asked -- and it got voted down because the republicans all voted against it as being utterly fiscally irresponsible and enough democrats joined in it to kill the bill. they wouldn't support it either.

a number of democrats who know that the budget has got to have some rationaleity, so they failed to do that. so if you put the doctor fix in here, you already are at a $120 billion deficit. so it does add to the deficit. it adds more than one dime to the dead. it adds it adds more than one dime to the debt t. it adds $120 billion to the debt. and another fiction was their promise that they would fix the physicians' payments and make a permanent policy of paying them so every year they wouldn't have to run to congress and hire lobbyists and come up here and meet with their senators to beg them not to have a 23% cut. that happens every year. it's ridiculous. but this bill does not deal with that. so it only has a one-year fix and for nine years, it's reduced. and just like has been done in

the past. and there's no reform in that part of health care that needs to be done. and another fiction is that they're not cutting medicare. they -- they're not -- they say, well, we're not cutting medica medicare, we're cutting that bad, old medicare advantage that 11 million seniors are benefiting from and enjoy and participate in. they're cutting that $100 billion-plus, which is about a fourth of what this cuts to medicare are. and they say that's not cutting medicare, but that clearly is cutting medicare because that's part of medicare program. and it is cutting medicare. and however you feel about medicare advantage, this is a cut to medicare programs that millions of seniors favor, and

that's what the -- why florida didn't want to have their medicare advantage cut. so they got a special deal in this legislation nobody else in america gets. they want to keep it. but let's go on a little bit further and just to show you why the american people are unhappy with congress. and they have a right to be unhappy. and people say, oh, those -- those people out there at the tea parties and town hall meetings, why, they were just upset. they are poor americans. they're not good americans. good americans would come in and say how much more money can we give you, big government, to take care of all our needs from cradle to the grave. i've got to tell you, the people at the tea parties understand

the kind of games that are being played here and they understand that the cuts to home health care, the cuts to hospice programs, the cut to hospitals, the disproportionate share moneys for poor that deal with hospital care for poor people and $23 billion from just general medicare accounts is a cut to medicaid -- medicare, which is our seniors' program. all right. now, so i will ask this questi question. how is it, then, that we have this disagreement? how is it possible that you can't agree on where $465 billion comes from? the sponsors of the bill, this is what they say. they say, we're not -- we promised we wouldn't cut

medicare benefits, any guaranteed benefit, any senior citizen has, we promised not to cut it. all we're doing is cutting the providers, the people who provide the benefit. oh, give me a break. and so you come in and you cut hospices, nursing homes, other providers, $118 billion from medicare advantage, $192 billion from the hospices, nursing homes and other providers, $43 billion from hospitals that serve a disproportionate number of poor and uninsured, $23 billion from unspecified medicare accounts. and that this doesn't weaken medicare. well, if we could cut that, why haven't we done it already? if this didn't make any difference, this didn't reduce the quality of care for seniors if we could reduce these hospitals and others and they could still provide care to our seniors, why haven't we done it

already? mike horsily, the head of our hospital association in alabama, tells me as a result of an abominable wage index program that determines how much hospitals get paid primarily and lean payments in general, two-thirds of the hospitals in alabama are operating in the r red. they don't need to be cut any more. so i guess what i would say to you, this is the way the game's been played. my colleagues are saying, we're not cutting guaranteed benefits. we're just cutting the money from the people who provide the benefits. well, how many of them are going to keep doing so, as the c.b.o., congressional budget office, questioned? how many of those will give it up?

and fiction number six -- i've got ten and i won't go through all of them tonight but fiction number six is that hospitals that treat the poorest and sickest will somehow be better off under this program, but they're not feeling that way. they're not feeling they're going to make up for the fact that the hospitals that qualify as disproportionate share hospitals, those who serve a high percentage of individuals who are very low income or who have no insurance, they're going to lose $43 billion in cuts under this bill, that these hospitals that provide so much charity care and provide a safety net in the communities are going to suffer under this legislation, and they are telling me that. i don't know who in washington may say they're not but that's what they're telling me. and i think they're telling the truth. and, mr. president, one of the

fictions is number five, is that average premiums are going to decrease. have you heard that? through this proposal? and senator evan bayh asked the c.b.o. about this and they said that families that do not receive coverage from their employer would see their premiums rise -- quote -- "about 10% to 13% higher by 2016" than under the current law. higher than under current law. and the ones that claim they're seeing some reductions, those reductions are only the slightest reduction, less than 1% in most cases of the 5% or 6% increase expected to consider every year under current law. so instead of going up 5.27%, it goes up 5.17% or something and they're claiming i guess that that's some sort of cut.

but it's misrepresentation to say that family premiums are going to decrease, that people who are not in group health plans through their employers are the ones that are going to see the largest increases, perhaps 10% to 13% by 2016, more than would occur under present law. mr. president, i am pleased to be able to serve in the senate with senator grassley, who's chaired the finance committee, who's ranking member now on the finance committee, who does interesting things like does 170 town hall meetings a year or something in the counties in iowa? and met with thousands of people and got the same message i think that i got, which is are you people irresponsible? it looks like to me they're asking us that you guys are

irresponsible, the debt is surging and will double in five years, the whole debt of america, and triple in ten. so i just would want to say th that - the american people are concerned about this. and senator grassley worked so hard to see if he could get a bill that would be bipartisan, that would we all could support, or large numbers of the senate could support, but we got off track. i talked to one person who dealt with this issue and he said the way things got off track was that we abandoned ways to legitimately contain cost increases. the way to create more competition, the more personal stake in your health care, other things that would actually help reduce the costs of health care,

that we got away from that and it became driven by president obama's determination to have a government option. and that's, i guess, was the decisive event in the negotiations breaking down. but, mr. president, this is a serious piece of legislation. it seems seeks to alter one-seventh of the american economy. it's not good, it does not do what it promises. it surges spending. it increases taxes dramatically, and it has a major governmental takeover and will ultimately undermine that special relationship between patients and their doctors. and it will also substantially threaten the viability of medicare, because this money that's being taken out of medicare will only accelerate its insolvency. by 2017, medicare -- i think

senator grassley would agree with that -- is expected to go into default. that is, expenditures will begin to exceed the income for the first time in the medicare history and it will go down rapidly, actually. and that -- is that correct, senator grassley, that by 2017 under current law, that medicare is projected to go into default and go rapidly into default and that if we could save any money out of medicare, if we can save $400 billion, shouldn't it be kept in the medicare program to try to extend its life and make it a continued viable program that our seniors can rely on rather than creating a whole new spending program for it with that money? mr. grassley: are you asking me to yield, i would yield on that

question. i would say he's absolutely right not based on what i say or you say, but every spring the trustees of social security and medicare look ahead 75 years and they predict what the income is and the outgo is going to be based on the population an projected growth of the -- and projected growth of the economy and all of that stuff. right now they're projecting $37 trillion -- $37 trillion of shortfall over that period of time. and they've already told us and it has materialized that in the year 2008, we started paying more money out of social security -- i mean out of medicare than coming into medicare. and by the year 2017, as you correctly stated, the trust fund will be out of reserves. mr. sessions: we're spending the reserves in social security that will be exhausted in social

security. mr. grassley: medicare. mr. sessions: medicare. i'm going to yield the floor, senator grassley. and i appreciate your leadership and insight into that issue and i value your whole approach to it. i think most americans, if they understood this -- the information as you do and as you have articulated it, the opposition to the bill would be even greater than it is. so i thank the chair. i urge my colleagues to examine the fact that the bill simply does not do what it sets out to do. does not meet its promises and, as a result, we absolutely should not go down this road to a major federal takeover of health care with ramfications that go far beyond what it might appear today. i thank the chair and would yield the floor. mr. grassley: mr. president? the presiding officer: the senator from iowa's recognized.

mr. grassley: i had a chance to hear a great deal of what the senator from alabama said. and i think i would highlight what he said is what he's hearing from the grassroots of his state, which is very much what i hear from the grassroots of my state, that people are very concerned about this piece of legislation leading to the nationalization of health care similar to what they've seen this administration previously do this year with the -- with the nationalization of general motors, partial nationalization of the financial system. a big deficit. and then they see the -- the money being spent on this bill bill, $2.5 trillion after it gets fully implemented that, where are you going to get the money and what's that going to do to the economy and, more importantly, what sort of legacy is that leaving to our -- to our -- our children and

grandchildren? and he also correctly stated that i do visit every county every year, the number of counties you had were just a little bit high. we only have 99 counties. for the 29 years that i've been in the united states senate, i have held a town meeting in each one much our counties every year since i've been in the senate. so i do have the been fit of 2,871 town meetings as a basis for suggesting what people tell me face-to-face besides the large number of phone calls we get. you can't believe the number of phone calls that are coming in now. the number of e-mails we're getting. historically high. i've never had that on any issue. and i assume it's the state of alabama contacting their two senators as well. mr. president, i rise to bring up this issue that is a relatively new issue in this debate as in the secrecy of the

negotiations that are going around this -- on capitol hill on the issue of health care reform. and these secret negotiations actually started about octobe october 2, when senator reid, the leader, had to merge the bill out of the senate finance committee, the bill out of the senate "help" committee into one bill. took a long period of time to do that. we're in the second week keefe bait and i hope that -- week of debate and i hope that people realize that 99 senators should have the same privilege that one senator had of getting a grasp of this huge 2,074-page bill. but there's still negotiations going on, because the leader still does not have locked down 60 votes that it will take to get to finality. so some of these discussions are what can we do to get a few

votes if we don't have a so-called public option? and the latest is that we'll allow people to buy into medicare. so i want to speak about that issue. it sounds pretty simple. it may get four more votes, it may get 60 votes, but it's bad. it may be good politically, but it's bad for medicare. particularly for medicare in rural areas where we have a difficult time keeping hospitals open and we have a difficult time recruiting doctors in rural america. so i would talk about recent news reports of a proposal being concocted behind closed doors to allow 55 to 64-year-olds to buy into the medicare program. supposedly this idea has been put on the table to get the votes for supporters of having a brand-new government-run health plan. and the people that don't like that. back in the spring such a

proposal came up during the early stages of our finance committee's health care reform. the idea was originally proposed by president clinton even going back to 1998. i opposed such a proposal back then, and i oppose such a proposal now. i oppose the proposal because it's negative -- its negative effect on medicare program and our senior citizens who use medicare. the best way to describe the effort of this proposal of the medicare program and its beneficiaries is t to quote forr senator phil gramm of texas, when he was asked of president clinton's proposal when president clinton put that proposal on the table in 199. senator gramm said this about the proposal, which would be

applicable today. quote, "if your mother is on the titanic and the titanic is sinking, the last thing on earth you want to be preoccupied with is getting more passengers on the titanic." since its inception in 1965, the medicare program has helped ensure seniors access to health care. but as the senator from alabama and i were just discussing, the problems with health care and medicare are such that medicare is already under extreme financial pressure. so why would you load more people into a system that senator gramm of texas was referring to as a titanic? you wouldn't load more people on it as it was going to sink. this is not to say that this entitlement program, medicare,

is not in need of improvement. but having the 36 million americans who are ages 65 -- or -- i'm sorry. ages 55 to 64, having them buy into the program is not an improvement. even groups supporting the reid bill, like the aarp, are pointing out the severe shortcomings of such an approach. last summer, the aarp public policy institute published an analysis of the medicare buying concept. in their report the aarp points out the potential for increased federal entitlement spending. the aarp said -- quote -- "expanding the program to put more people could raise federal spending even further if their care is made affordable through subsidies that would be funded

by the existing medicare trust funds." and don't forget the effect of adverse selection from a medicare buy-in program. here aarp has studied it. this is what they say about that -- quote -- "the premium may be too uncompetitive for those who don't use much health care. and unaffordable for those with modest incomes. this may limit buy-in enrollment and drive up costs further." end of aarp quote. so this means that this buy-in proposal is likely unsustainable. and we all know what happens when the government creates an unsustainable new program. what happens? the taxpayers end up on the hook for bailing it out down the road sometime. we all know that the medicare

program has $37 trillion in unfunded obligations. we all know about the pending insolvency of the medicare program, the trustees say so every spring. the medicare hospital insurance trust fund started going broke last year. in 2008, then, the medicare program began spending more out of the trust fund than was coming in through the payroll tax. the medicare trustees have been warning all of us for years that this trust fund is going broke. they now predict that it will go broke right around the corner in 2017. well, by adding millions, as aarp has pointed out, adding millions to the medicare program would also certainly make things much, much worse for the fiscal

health of a program that's not in very good financial shape. this proposal would also make things worse for the 45 million medicare besh ri beneficiaries d into the program over the years and are receiving benefits under the program. since we started debate on this 2,074-page bill, members on this side of the aisle have questioned the wisdom of slashing medicare by half a trillion dollars and then using the savings to start up a new federal entitlement program. we on this side have stressed that provider cuts of this magnitude will make it financially harder for providers to care for beneficiaries. and we have pointed out that this will worsen beneficiary access to health care as providers stop treating medicare patients. adding millions more americans

to medicare on top of the half a trillion dollars in medicare cuts in this reid bill would make beneficiaries access to care much worse. but don't take my word for it. even the national hospital associations, like the american hospital association and the federation of american hospitals respect opposing this proposal. they're mobilizing their ranks against this proposal even as i speak. yes, mr. president, the same groups that agree -- that agreed already, and this is back in june to the tune of $155 billion in medicare cuts, and they did that in agreement with the white house, and got sweetheart deals in this bill, do not want the senate to go the route of expanding medicare for people

under 65 years of age. the american medical association has also opposed this proposal. these groups recognize the potential for financial disaster by boosting the number of patients with coverage that pays well below costs. this medicare buy-in proposal would also jeopardize retiree benefits going back to the same aarp analysis that i quoted, they concluded that a medicare buy-in program could further reduce employer-sponsored health benefits. according to the aarp, i quote -- "a buy-in program might displace retiree coverage now available through their employers." still quoting aarp they said -- quote -- "as health care costs tend to drive -- to rise with age, employers might have the

incentive to find ways to avoid offering private coverage for early retirees." end quote. so with fewer patients, with higher paying private coverage, there is less opportunity for providers to cost shift to makeup for low medicare payments. because everybody recognizes the federal government does not pay 100% of costs. this would make it even harder for providers to treat medicare beneficiaries and as a result beneficiaries would have an even harder time to find a provider to treat them. i come from a rural state where medicare reimbursement is already lower than almost every other state in the nation, so i have serious concerns about the ability of the iowa providers to keep their doors open if more

and more of their reimbursement is coming from medicare. i know this is a concern that is shared by rural state members of this body from both sides of the aisle, but losing providers to serve medicare beneficiaries would only be the beginning of access problems caused by medicare buy-in program. because if you think it would be tough to keep existing medicare providers, think how hard it would be then to recruit new ones. provider recruitment is already a major problem in rural states, particularly my state of iowa. this issue comes up during my meetings with constituents in washington or during the town meetings i hold in each of iowa's 99 counties every year. it's already a challenge under the current medicare program for iowa to compete for providers

with urban areas where medicare reimbursement is higher. i hear countless stories from constituents where they make great efforts to recruit doctors, only to lose them to areas where medicare reimbursement is higher. but the medicare buy-in is only only -- will only make this situation worse in my state of iowa because more and more reimbursement would come from medicare. so the current and future medicare beneficiaries would be assured of limited access to providers because of this buy-in. aarp pointed out another flaw in this buy-in proposal. in their analysis, aarp warned that there are large cost-sharing requirements in medicare, so buy-in enrollees

would still be exposed to significant cost sharing. maybe these buy-in enrollees would have the resources to purchase supplemental medicare policies to defray these cost-sharing requirements. perhaps aarp is thinking of making even more money by selling supplemental policies to these retirees. i share the goal of getting more americans covered, but expanding the medicare program to early retirees is not the answer. medicare beneficiaries have paid into the program all these years and rightfully have the expectation to receive the benefits to which they are entitled under the program. the medicare buy-in proposal would jeopardize these benefits. it would jeopardize existing retiree benefits. it would leave retirees exposed

to significant cost sharing. it would be unsustainable and taxpayers would end up footing the bill. i yield the floor. mr. casey: mr. president? the presiding officer: the senator from pennsylvania. mr. casey: mr. president, thank you very much, and i rise tonight to continue the discussion and debate on health care. i have had the chance over the last couple of months to -- not only to do a good bit of work on a number of issues that relate to the bill and the two bills that came before it was merged into one bill, but also to hear from constituents across

pennsylvania. some of them writing to us and urging us to pass a bill and some urging us to go in the other direction. but the communications that i get from -- from people that write about their own stories, their own family, their own challenges are, of course, the most compelling and the most worthy of time and attention, and often they come from pennsylvanians who are not only facing health care challenges but facing -- facing economic challenges that i don't think anyone in this chamber can really fully understand, at least not at this part in someone's life, because when you become a member of congress, you're usually in pretty good shape. you may not have a lot of wealth, but you at least have a

job to go to every day, you have a lot of people helping you, and you have health care, and that's not something that can be said for tens of millions of americans. and this legislation is -- is legislation that i think is the culmination of a lot of debates and discussions and analysis and study over many, many decades now, and it's nice that we have been talking for years and years about -- about preventing a pre-existing condition from barring someone's coverage or treatment. it's nice to talk about it, but it's a lot better when we can do something about it. it's nice that we have talked about limiting out-of-pocket costs for -- for families that are trying to -- to take care of their children and trying to care for themselves, but it's also -- it's a lot better to do

it, to enact it into law, and this bill makes it illegal to use pre-existing conditions to deny someone coverage. this bill makes it illegal for insurance companies to put a -- a cap -- a lifetime cap on services or an annual cap. this bill makes it illegal to discriminate so that no longer longer -- if we do what we must do and get this bill passed, no longer can an insurance company discriminate against a woman, which they do all the time now, just like they prevent people from getting coverage due to a pre-existing condition. and we have an opportunity to change the way we provide health care in ways that we can't even -- we haven't been able to imagine let alone enact into law.

one issue that has motivated me throughout this whole debate is -- is what happens to our children at the end of the debate, at the end of the legislative line, so to speak? will children in america -- and i'm speaking about poor children and those with special needs here, because they are the ones that need help. if you're in a wealthy family, you will figure it out and your family will figure it out. but if you happen to be a child in a poor family or a child who has special needs, will you be better off at the end of this debate or will you be worse off? and as it relates to poor -- poor children and children with special needs, the goal here has to be no child worse off. very simple. it's a very simple test, and that's what we have been working on, and i believe this bill

that's on the floor right now is a -- is a dramatic improvement in the lives of so many families, but i still think we have some more work to do as it relates to children. but there's no question that the bill that we're debating will make the children a priority in ways that we haven't been able to do in any other legislation other than the children's health insurance legislation that we -- that congress enacted going back a decade -- more than a decade ago and that we re-authorized this past year. i wanted to speak about two families tonight. these aren't -- this isn't a discussion about theory or about the nuances of a policy. this is about real people and what has happened to them under our existing system.

i wanted to put up the first chart here. this chart depicts one family, the ritter family in manheim, pennsylvania. i spoke of them several days ago, and i spoke of these two young girls. one daughter's name is hannah -- one twin, i should say, is hannah, and her sister -- after i spoke on the floor, i called their mom to talk about what i had said on the floor, and i said to her -- i said i think i referred to one of your daughters as madeline, and that's incorrect. it's madeleine. i want madeleine to know i pronounced her name correctly the second time around. part of that is a story i read

to my daughters when they were little, my wife read it a lot, it's the story of madeline. i apologize to stacie ritter. here's the story stacie ritter has told me through this communication and now i have told a lot of other people and we have told on the senate floor to give meaning to what we're talking about here, because this isn't some -- this isn't some public policy discussion about health care. this is about what happens to real families when we don't get the policy right. when we talk and talk year after year, decade after decade and talk about good intentions but never get it done, never get a bill passed, this is what happens to people. stacie ritter had to declare bankruptcy after her twins were diagnosed with leukemia at the age of 4. now, my wife teresa and i have

four daughters, and thank goodness they are all healthy. two of them are in college, one is in high school, and one is in seventh grade. we have never had to face that kind of diagnosis. thank goodness, thank god that i have never had to face that, nor has my wife teresa had to face that as a parent. but if we did, we would have been given some protection and so would our daughters if we faced that horrific diagnosis because when i was working as a lawyer or when i was a public official, i had health care. and sometimes for a lot of that time period, a decade in state government, health care -- because i was a state employee and had a tremendous health care plan, a kind of public option. a good -- a really good public health care plan.

so i never had to worry about that as a parent nor did my wife if something horrific were diagnosed. these two little girls pictured here, and you can see even though because of that diagnosis , they are facing the kind of challenge that i can't even imagine, let alone -- let alone endure. i hope i could, but i'm not sure if i -- that i could if i were in their place. but you can see even though it's obvious that they are facing a real challenge there with regard to the leukemia, they are very hopeful, aren't they, in that picture? they are -- they have got their arm around each other, they have these stethoscopes, and they are dressed up like two doctors. so even in the midst of that -- the horror of that kind of a diagnosis, you have these two brave little girls who are looking forward, not just worried about their own situation but looking forward with hope and optimism.

and here's a picture down here taken last year in washington, d.c., then at the age of -- at the age of 11. and here's what their mother said -- "without meaningful health reform, my girls will be unable to offered care, that is if they are even eligible for care that is critically necessary to maintain this chronic condition. punished and rejected because they had the misfortune of developing cancer as a child." now, what is the -- what is the particular problem here with this case? the obvious problem is that these young girls were diagnosed with leukemia. that's bad enough, but we have a system that made their life a lot worse than just the leukemia, because we had a